• Black Nova Scotia
  • Economy
  • Education
  • Environment
  • Health
    • COVID
  • Investigation
  • Journalism
  • Labour
  • Policing
  • Politics
    • City Hall
    • Elections
    • Province House
  • Profiles
  • Transit
  • Women
  • Morning File
  • Commentary
  • PRICED OUT
  • @Tim_Bousquet
  • Log In

Halifax Examiner

An independent, adversarial news site in Halifax, NS

  • Home
  • About
    • Terms and Conditions
    • Commenting policy
  • Archives
  • Contact us
  • Subscribe
    • Gift Subscriptions
  • Donate
  • Swag
  • Receipts
  • Manage your account: update card / change level / cancel
You are here: Home / Featured / Code critical: patients waiting hours to be transferred from ambulances to emergency departments

Code critical: patients waiting hours to be transferred from ambulances to emergency departments

Report finds all four health zones saw increase in offload times. Union says of shortage of paramedics, nurses, lack of access to family doctors, and patients occupying hospital beds while waiting to get into long-term care are behind the offload times.

September 27, 2021 By Jennifer Henderson 1 Comment

An ambulance driver gets into his vehicle, preparing to leave the Emergency bay at a hospital.

Last month nine out of 10 patients ambulanced to the QEII Health Sciences Centre Emergency Department waited more than six hours to be admitted. Six hours and 42 minutes, in fact.

That disturbing information is contained in the Ambulance Offload Times report for last month prepared for Nova Scotia Health (NSH) and submitted to the Health minister. It confirms what many already knew: the situation on the front lines is getting worse.

Former Health Minister Zach Churchill became alarmed last April when it was clear overcrowded emergency departments were creating a bottleneck. More and more ambulances were unable to respond to new calls because they were tied up outside the emergency department waiting to discharge patients. The grieving families of Kelly MacPhee and April George have spoken out publicly about their frustration watching loved ones die waiting for an ambulance to show up.

The target or benchmark set by the province is 30 minutes to off load 90% of patients arriving at emergency departments. After 30 minutes, the paramedic/ambulance driver is supposed to be free to respond to another call.

That goal increasingly looks like a cruel fantasy. The situation at the Halifax Infirmary has even deteriorated since June, when patients being transported by ambulance waited four hours in the parking lot or in the hospital corridor. We’ll look at the factors contributing to those numbers in just a moment.

The data in the August report show all four health zones across the province saw an increase in the wait time for ambulances at emergency departments.

A graph showing ambulance offload times at various districts.

At Colchester East Hants Health Centre in Truro, nine out of 10 ambulances waited more than three hours at Emergency. In June that would have been a two-hour wait. At Cape Breton Regional Hospital, the wait time was one hour and 20 minutes, or nearly three times the half-hour benchmark. The South Shore Regional Hospital in Bridgewater reported nine out of 10 patients waiting two hours to be admitted to its emergency department.

Wait times to deliver patients into care were even longer across the Halifax Regional Municipality.

During the first three weeks of August, ambulances waited four hours to offload patients at the Cobequid Community Health Centre in Sackville. Cobequid ER nurse manager Jamie Stewart described working conditions “as a war zone” in a recent interview with The Current on CBC Radio. Stewart described one night early in September when the 30 beds were full, 44 patients were in the waiting room, and eight ambulances were lined up outside. The Sackville community health centre isn’t supposed to be open after midnight, but the same tired staff continued to work through to the next day to handle the backlog of patients.

Meanwhile at the Dartmouth General Hospital, paramedics averaged more than three hours (185 minutes) waiting to discharge their patients. On August 10, 86-year-old Ross O’Brien of Dartmouth fell and broke his hip, then waited three agonizing hours for an ambulance to arrive.

“Code Critical”

“Code Critical” is the hashtag used by paramedics to indicate an area is without an ambulance — a phrase repeated several times a day during August. Both Nova Scotia Health and the unions involved suggest the most probable explanation for increased wait times outside emergency departments is a combination of summer vacations and “an unprecedented shortage of nurses.” That leaves large areas of the province without coverage in the event of a heart attack or car accident.

“There is a shortage of paramedics,” said Michael Nickerson, the president of the Nova Scotia Paramedics union (IUOE Local 727). He estimates as many as 200 are out on disability or stress leave. “But a bigger problem is the shortage of nurses combined with the lack of access to family doctors and people occupying beds in hospitals because they are waiting to get into long-term care (nursing homes).”

Nickerson believes the dramatic increase in offload times at the Halifax Infirmary last month was because there weren’t enough nurses available to staff all the “pods” or units at the hospital. In mid-July, Nova Scotia Health vice-president Colin Stevenson confirmed to CBC News that some services might have to be cut because hospitals were so short of registered nurses. Stevenson said summer began with 20% of nursing positions unfilled across the province. Nova Scotia Health estimated as many 200 RNs and LPNs had left jobs in hospitals to help public health with vaccinations and contact tracing.

In HRM alone, there were 19 vacancies for emergency department personnel that weren’t expected to be filled until September. The Examiner asked NSH for its explanation for the increase in ambulance offload times, particularly in Metro. Here’s a response from Brendan Elliott, senior communications manager for NSH.

Ambulance offload times are influenced by many factors, including emergency department volumes, the number of admitted patients within the health system, the number of hospital inpatients who would be better served in another setting, and overall staffing levels. Over the past several months, Nova Scotia Health – much like other health systems across North America – has experienced very high demand for service, with increased visit volumes and increased admissions to our emergency departments.

Elliott continues:

This increase has been experienced at a time when we have also been facing significant workforce challenges. In addition, overcrowding in emergency departments is a symptom of difficulties transferring patients elsewhere in the system, whether it’s into long term care or another setting in the community…Nova Scotia Health is committed to working every day to improve access and flow across the system, including timely offload of ambulances.

Will nurses return or not?

As vaccination clinics ramp down, Nova Scotia Health is hoping nurses will return to work in hospitals. But union leaders have suggested people are quitting or retiring because they are tired and there aren’t enough of them to provide the care required for critically ill patients during a pandemic. In Quebec, the government of Francois Legault is offering nurses $12,000 to 18,000 bonuses if they will come back to work full-time.

After a series of meetings around the province, Premier Tim Houston acknowledged on Friday the ongoing and worsening delays for paramedics who are waiting to offload patients at hospital emergency departments. “Many of the health-care providers we spoke with mentioned our ambulance system as a key area for improvement,” Houston  “Suggestions to free up front-line staff from non-emergency tasks like routine transfers is something we can do in the short-term. This will alleviate pressure and ensure our paramedics can focus on the emergency care people need quickly when they call 911.”

The van plan

Let’s hope so. Since April, the province has bought three Ford Transit vans for a pilot project to see if more patients who are not critically ill can be transported in a vehicle other than an ambulance between hospitals for tests and medical appointments. Finding a different vehicle for moving non-urgent cases was a key recommendation contained in the Fitch Report delivered to the Liberal government in 2019. The report found paramedics spent 47% of their time driving non-urgent cases between hospitals instead of responding to actual life or death emergencies.

The Progressive Conservative government is considering buying more vehicles to relieve some of the pressure on paramedics. However, the current criteria for the pilot project may be flawed since it limits how many patients can use the service.

The driver of the van is trained in CPR and first aid, but patients must be capable of walking or using a wheelchair, because the driver leaves once patients get dropped off. Many residents of long-term care facilities are too frail to walk so the vans saw limited uptake from nursing homes in the early days of the pilot project. Emergency Health Services has also added medical staff to its communications centre to triage incoming calls and offer alternatives — such as calling 811 for medical advice or the mental health crisis line — in situations where an ambulance may not be the appropriate response.

As a premier who campaigned on a promise to “fix health care,” Tim Houston didn’t have to wait long before being tested by the challenge of long waits.


Subscribe to the Halifax Examiner


We have many other subscription options available, or drop us a donation. Thanks!

Filed Under: Featured, Health, News

About Jennifer Henderson

Jennifer Henderson is a freelance journalist and retired CBC News reporter. email: [email protected]

Comments

  1. Colin May says

    September 27, 2021 at 10:17 am

    I hope the province cuts the amount of money it gives HRM for certain operating and capital expenditures. HRM is sitting on a large amount of cash. For almost 20 years the province has given HRM $3.6 million a year to fund 40 police officers and the amount is a rounding error in the accounts of HRM . Take the money and spend it on what I call ‘the essentials’ – housing and/or healthcare.

    Log in to Reply

Leave a Reply Cancel reply

You must be logged in to post a comment.

PRICED OUT

A collage of various housing options in HRM, including co-ops, apartment buildings, shelters, and tents
PRICED OUT is the Examiner’s investigative reporting project focused on the housing crisis.

You can learn about the project, including how we’re asking readers to direct our reporting, our published articles, and what we’re working on, on the PRICED OUT homepage.

2020 mass murders

Nine images illustrating the locations, maps, and memorials of the mass shootings

All of the Halifax Examiner’s reporting on the mass murders of April 18/19, 2020, and recent articles on the Mass Casualty Commission and newly-released documents.

Updated regularly.

Uncover: Dead Wrong

In 1995, Brenda Way was brutally murdered behind a Dartmouth apartment building. In 1999, Glen Assoun was found guilty of the murder. He served 17 years in prison, but steadfastly maintained his innocence. In 2019, Glen Assoun was fully exonerated.

Halifax Examiner founder and investigative journalist Tim Bousquet has followed the story of Glen Assoun's wrongful conviction for over five years. Now, Bousquet tells that story as host of Season 7 of the CBC podcast series Uncover: Dead Wrong.

Click here to go to listen to the podcast, or search for CBC Uncover on Apple podcasts, Spotify, or any other podcast aggregator.

The Tideline, with Tara Thorne

Two young white women, one with dark hair and one blonde, smile at the camera on a sunny spring day.

Episode 79 of The Tideline, with Tara Thorne, is published.

Grace McNutt and Linnea Swinimer are the Minute Women, two Haligonians who host a podcast of the same name about Canadian history as seen through a lens of Heritage Minutes (minutewomenpodcast.ca). In a lively celebration of the show’s second birthday, they stop by to reveal how curling brought them together in podcast — and now BFF — form, their favourite Minutes, that time they thought Jean Chretien was dead, and the impact their show has had. Plus music from brand-new ECMA winners Hillsburn and Zamani.

Listen to the episode here.

Check out some of the past episodes here.

Subscribe to the podcast to get episodes automatically downloaded to your device — there’s a great instructional article here. Email Suzanne for help.

You can reach Tara here.

Sign up for email notification

Sign up to receive email notification when we publish new Morning Files and Weekend Files. Note: signing up for this email is NOT the same as subscribing to the Halifax Examiner. To subscribe, click here.

Recent posts

  • Last week tied the record for weekly COVID deaths in Nova Scotia May 20, 2022
  • National study to assess pandemic’s health impacts, potential long-term effects of COVID-19 May 19, 2022
  • NSTU president concerned about conflict as province announces end to mask mandate in schools May 19, 2022
  • Royal flush: the monarchy’s role in reconciliation and Canada today May 19, 2022
  • Dartmouth man charged with wilful promotion of hatred May 19, 2022

Commenting policy

All comments on the Halifax Examiner are subject to our commenting policy. You can view our commenting policy here.

Copyright © 2022